血栓弹力图在检测血小板减少孕妇凝血功能中的应用  

Application of thrombelastogram in the determination of coagulation function during pregnancy

作　　者：黄吉娥[1] 涂飞[1] 杨芳[2] 曾小菁[1] 祝丽丽[1] 赵鲁强[1] HUANG Jie TU Fei YANG Fang ZENG Xiaojing ZHU Lili ZHAO Luqiang(Guizhou Medical University Affiliated Hospital, Guiyang 550004, China Guizhou Medical University.)

机构地区：[1]贵州医科大学附属医院,贵州贵阳550004 [2]贵州医科大学

出　　处：《中国输血杂志》2016年第8期820-822,共3页Chinese Journal of Blood Transfusion

摘　　要：目的 探讨血栓弹力图（TEG）检测妊娠晚期伴血小板减少的孕妇的凝血功能,评估其凝血功能,预测生产过程中出血的风险。方法 血小板减少的孕妇42例、血小板正常孕妇30例应用血栓弹力图仪检测R时间、K时间、Angle角、MA值以及CI值;72例标本均应用凝固法（磁珠法）测定凝血4项PT、APTT、TT、Fg及光散射法进行Plt计数检测。结果 血小板减少组Ⅰ（Plt〈50×10^9/L）、Ⅱ[Plt（50-100）×10^9/L]与正常对照组Ⅲ[Plt（100-300）×10^9/L]TEG参数MA值Ⅰ/Ⅱ组和Ⅰ/Ⅲ组两两比较差异均具统计学意义（P〈0.05）;K时间、Angle角及CI值Ⅰ/Ⅲ组间比较差异具统计学意义（P〈0.05）;R时间各组间两两比较差异均不具统计学意义（P〉0.05）;MA值、K时间及CI值在失血量≥800 m L组与〈800 m L组比较,A/C组、B/C组之间差异均具统计学意义（P〈0.05）;凝血4项中PT、APTT、TT血小板减少组与正常对照组之间两两比较,差异均不具统计学意义（P〉0.05）,Fg血小板减少组分别与正常对照组比较,差异均具统计学意义（P〈0.05）。结论 TEG结果中的MA值、CI指数、K时间是评估血小板减少孕妇生产过程中出血风险的主要指标,且各参数低至某一界限后出血量与死亡率明显增加。Objective To utilize the thrombelastogram （TEG） to evaluate coagulation function during pregnancy and to predict the potential risk of hemorrhage during delivery . Methods Forty two pregnant women with thrombocytopenia, ineluding 20 with Ph 〈 50 × 10^9/L （group Ⅰ） and 22 with Ph （50 - 100） × 10^9/L （group Ⅱ ） and 30 normal pregnant with Ph （100 -300 × 10^9/L） （ group Ⅲ ） were measured and analyzed on reaction time （R） , clotting time （K）, α angle, maximum amplitude （MA） and coagulation index （CI）. Simultaneously, the PT, APTT, TT, Fg in above samples were determined with a freezing method （ magnetic beads method） and the Pit count was recorded using the light scattering method. Results Compared with group Ⅰ , significant difference （ P 〈 0. 05 ） was observed in MA and Fg. Significant difference （P 〈 0.05） was also observed in K, α angle and CI between groups Ⅰ and Ⅲ, but no significant difference was observed between groups Ⅰ and Ⅱ. In addition, the parameters according to the TEG is divided into groups A, B, C which were studied. From the correlation of MA, K and CI with the amount of hemorrhage, a significant difference in the amount of blood loss （ ≥800mL or 〈800 mL） was found between groups A and group C, and groups B and C, respectively （P 〈0. 05）. Conclusion TEG could be used as a useful indicator to monitor blood coagulation in pregnant women with thrombocytopenia. When the parameters are low to a certain limit, the amount of bleeding and the rate of mortality increase significantly.

关 键 词：血栓弹力图 妊娠 血小板减少 出血 

分 类 号：R457.1[医药卫生—治疗学]